NPIMap

Organization Active NPI

Summersville Out Patient Center

  • Family Medicine Physician
  • Summersville, WV
National Provider Identifier
1750378345
Registry record updated Sep 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61 Issued in WV
Legal business name
SUMMERSVILLE OUT PATIENT CENTER
Practice address
400 Fairview Heights Rd
Summersville, WV 26651-9308
Phone
(304) 872-5124
Fax
(304) 872-0675
NPI assigned
Sep 29, 2005
Last updated
Sep 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debbie Hill, MBA
Title
Ceo
Phone
(304) 872-8402

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 61 WV
Clinical Medical Laboratory 291U00000X 51D0933140 WV
Family Medicine Physician 207Q00000X 61 WV Primary

Addresses

Primary practice location

400 Fairview Heights Rd
Summersville, WV 26651-9308

Mailing address

400 Fairview Heights Rd
Summersville, WV 26651-9308
Phone (304) 872-5124

Other identifiers 2

IdentifierTypeStateIssuer
0034931000MedicaidWV
0034931003MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Richwood Family Practice5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

74 Avenue B
Richwood, WV 26261
Phone (304) 846-4980

400 Fairview Heights Rd
#204
Summersville, WV 26651
Phone (304) 872-8536

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1750378345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FAIRVIEW HEIGHTS RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519308",
            "telephone_number": "304-872-5124",
            "fax_number": "304-872-0675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FAIRVIEW HEIGHTS RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519308",
            "telephone_number": "304-872-5124",
            "fax_number": "304-872-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERSVILLE OUT PATIENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-872-8402",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WV",
            "license": "61",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WV",
            "license": "51D0933140",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "61",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0034931000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0034931003",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summersville, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.